December 11, 2017
2 min read

Lower plasma NT-proBNP levels common in black patients

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Black patients had lower plasma N-terminal pro-B-type natriuretic peptide levels compared with white patients, according to a study published in JAMA Cardiology.

Higher NT-proBNP levels were linked to an increased rate of CV mortality and all-cause mortality in healthy white and black patients.

Navkaranbir S. Bajaj, MD, MPH, clinical fellow in radiology at Brigham and Women’s Hospital, and colleagues analyzed data from 1,998 patients (median age, 63 years; 49% black; 49% women) from the REGARDS study. Patients were excluded if they had prevalent CVD, missing NT-proBNP measurements or HF.

Data from the Dallas Heart Study and the ARIC study were used in meta-analyses.

Black patients had lower NT-proBNP levels (46 pg/mL) compared with white patients (60 pg/mL; P < .001). After multivariate adjustment, NT-proBNP levels were 27% lower in black patients vs. white patients (beta = –0.32; 95% CI, –0.4 to –0.24; P < .001).

Among all three cohorts, black patients had NT-proBNP levels that were 35% lower than white patients (P < .001).

The multivariable-adjusted model of patients from the REGARDS study showed that for every 1-standard deviation higher log NT-proBNP, the risk for death increased by 31% (HR = 1.31; 95% CI, 1.11-1.54), which was driven by the link between CV mortality and NT-proBNP (HR = 1.69; 95% CI, 1.19-2.41).

After adjusting for established risk factors, race and NT-proBNP levels did not interact with all-cause mortality (P = .96) and CV mortality (P = .36).

“Our findings suggest that NT-proBNP levels are lower in black vs. white individuals, which makes the argument for reporting race-specific NT-proBNP values in individuals free of prevalent CV and renal disease,” Bajaj and colleagues wrote. “This finding is particularly relevant since American College of Cardiology and American Heart Association guidelines provide cutoff values of NT-proBNP levels that are not stratified by race to rule out heart failure in ambulatory patients.”

“These emerging data underscore the important influence of noncardiac factors on the natriuretic peptide system, but further studies are needed to understand the underlying mechanisms,” Thomas J. Wang, MD, director of the division of cardiovascular medicine, physician-in-chief at Vanderbilt Heart and Vascular Institute, professor of medicine and Gottlieb C. Friesinger II chair in cardiovascular medicine at Vanderbilt University Medical Center in Nashville, wrote in a related editorial. “For instance, it is unknown whether race/ethnicity, obesity and genotype affect the natriuretic peptides vs. altered production, clearance or both.” – by Darlene Dobkowski

Disclosures: The study authors and Wang report no relevant financial disclosures.